SC curs ssm SRL

DECLARATIE

Subsemnatul(a).......................................................................................
domiciliat(a)......................................................................................................
salariat(a) la SC curs ssm SRL,
avand functia de ......................................................................, declar pe
propria raspundere ca:

1. Am / nu am alergie
la: ......................................................................................................................
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2.Sunt / nu sunt suferind de boala cronica si anume:

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3.Sunt / nu sunt suferind de alte boli:

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Declar ca am luat cunostinta de obligatiile pe care le am privind respectarea

normelor de protectia muncii si ma angajez sa le respect.

Data: Semnatura: